If your child has ever suffered an ear infection, chances are your doctor opted to prescribe an antibiotic right away. But ear infections do not always require antibiotics. In some cases, it might be best to choose a "watchful waiting" approach over antibiotics.

Various pediatric organizations are emphasizing this approach to treating ear infections. Read on to learn about the watchful waiting approach.

What does watchful waiting mean?

The Canadian Paediatric Society has recommended the watchful waiting approach (sometimes called "watch and wait," or "observation option" as referred to by the American Academy of Pediatrics) in response to the alarming increase in antibiotic resistance in recent years due to overuse of antibiotics. The recommendation also allows children with uncomplicated ear infections to avoid potential side effects from the use of antibiotics.

The observation option involves postponing antibiotics for up to the first 72 hours after a child develops an ear infection. During this time, only medications to treat symptoms and pain are given. Antibiotics are only given if symptoms do not go away or get worse after the observation period.

This approach should only be used under the advice of your doctor. If you suspect your child has an ear infection, you should visit the doctor right away. Your doctor will help you decide whether or not your child needs antibiotics. If the "watchful waiting" approach applies to your child, your doctor may tell you to monitor your child and to bring them back to the doctor if their symptoms get worse or do not improve within 2 days. Alternatively, your doctor may give you a prescription for antibiotics and instruct you to only fill it if your child's symptoms do not improve or get worse within 2 days.

Why wait?

Many studies have shown that children with an ear infection will get better even if they do not take antibiotics. The observation method has been used in many countries outside of North America, such as The Netherlands, Denmark, and Norway, and there have been no increase in complication rates with this option. In fact, studies have shown that 61% of children's symptoms improve within 24 hours whether they are taking antibiotics or not taking antibiotics. Symptoms completely go away after about 7 days for about 75% of children with or without using antibiotics.

If your child is given antibiotics when they don't need it, they may suffer unnecessary side effects such as rash, diarrhea, upset stomach, and yeast infection. In addition, frequent use of antibiotics can lead to resistance, which means that an antibiotic may not work on your child for a future infection.

Another reason not to use antibiotics right away is because ear infections diagnoses are sometimes wrong or are caused by viruses, not bacteria.

Watchful waiting vs. antibiotics

Watchful waiting may not be appropriate for all children. Observation is best for children that are 6 months or older who have mild symptoms, and when proper follow-up care is possible. Immediate antibiotics are best for children under the age of 6 months or in children with severe symptoms, including a fever of 39°C or higher.

The watchful waiting approach is not recommended for children with certain conditions, including Down syndrome, a compromised immune system, or those with cleft palates or cochlear implants. They also do not apply to children who are suffering a second ear infection within 30 days of another, or who have chronic ear infections.

If you suspect that your child has an ear infection, see your doctor immediately.